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As a veterinarian, I sometimes encounter a problem when I meet new people. Some become excited — to the point of obsession — when they meet a veterinarian outside of a veterinary clinic. They have a tendency to hijack conversations in order to focus on animal-related topics and questions. They also aren’t shy about asking for free advice. Over the years, I have developed a pretty good ability to identify such people. When such a person asks me what I do for a living, I generally tell them I sell insurance. It’s a trick that has not failed me yet.

Therefore, I experienced quite a sense of irony last week when I was in the office of an insurance agent. He had brought his dog, a five-month-old Labradoodle, to work. He knew my occupation, and we spent much more time talking dogs than talking insurance.

Photo of Dr. Eric Barchas by Liz Acosta.

As I was dispensing free advice — free or even discounted insurance was not offered in return, FYI — the agent asked me about neuter surgeries. He had established a relationship with one of the most reputable veterinarians in town. But he wondered about their prices. He thought they were expensive, and he was considering having the surgery performed at a different, low-cost clinic. What did I think about that? Would it matter where the procedure was performed? Neuters are routine surgeries anyway, right?

Of course not. “Routine surgery” is a contradiction in terms.

Yes, veterinarians perform neuters and spays all the time. Yes, most of us have done thousands of them. And yes, they generally are very safe. But they should not be taken lightly. Neuters and spays are real surgeries, and you want them done right because if something goes wrong the outcome can be fatal.

Several months ago, a gentleman brought his German Shorthaired Pointer to see me. The dog had been neutered the day before, and the dog had been lethargic since the surgery. The lethargy had been progressive, and by the time the dog came to me, he was too weak to walk.

I examined the dog. His gums were white (they should be pink). He was weak and could stand only with difficulty. His pulses were thready. His neuter incision was clean and intact with no external swelling or evidence of complications.

The complications were internal. An ultrasound of the dog’s abdomen revealed that it was full of blood. The dog was dying of internal bleeding.

To neuter a dog, an incision is made behind the penis. One at a time, each testicle in maneuvered into the incision. The blood supply to the testicle is tied off, or ligated, with suture material to prevent hemorrhage when the testicle is removed. After both testicles are out, the incision is closed.

In this case, one of the ligatures had failed. Testicles start their lives inside of the abdomen, and during development they move through a structure called the inguinal ring to pass into the scrotum. The artery that supplied blood to the testicle had retracted back through the inguinal ring into the abdomen, and it was releasing blood into the abdomen.

After two days of hospitalization and several blood transfusions, the dog recovered. He had a very close call, but he will live a normal life.

Another dog seen at my office was not so lucky. She was presented the day after her spay surgery for lethargy and weakness. She also had pale gums, weak pulses, and an abdomen full of blood.

To spay a female dog, an incision is made in the abdomen. Each ovary is identified, and its blood supply is cut off with at least one ligature (back when I did lots of spays, I actually used at least two, and more often three ligatures for each ovary). The blood supply to the main portion of the uterus is similarly ligated, and the uterus and ovaries are removed. Internal bleeding is a well-known complication of spay surgeries, and it usually happens when one of the ligatures fails (which is why many vets use multiple ligatures at each site — if one fails, there are backups).

A failed ligature was assumed to be the cause of the dog’s symptoms. In females with internal bleeding after sterilization surgery, a second surgery usually is necessary to stop the bleeding. I worked with another veterinarian at the office to perform the surgery. We identified all three arteries. The ligatures were in place. The source of the bleeding turned out to be a large laceration on one of the dog’s kidneys. The kidneys receive almost a third of the body’s blood; trauma to the kidneys causes profuse hemorrhage. The dog, I am very sorry to say, did not survive.

This brings me back to my insurance agent. Spays and neuters are safe, I told him. I have performed thousands of them without complications. But you want them to be performed by someone who will be very careful. You want someone who will double or triple ligate all of the arteries, who will check carefully for bleeding, and who will stay away from the kidneys. You want someone who only has a few surgical patients on any given day, so that your pet will be his focus the whole time your dog is under his care.

And when it comes to spays and neuters, I recommend paying more. Surgery, when it’s done right (which is how it’s safest), costs more. Intravenous fluids, dedicated monitoring devices and personnel, pre-anesthetic blood work, and proper pain control cost money. They’re well worth that money.

If your dog is going to be spayed or neutered, I recommend that you take her to a veterinarian you know and trust. A good veterinarian will be happy to discuss the procedure and the precautions she takes to prevent pain and complications. Don’t be afraid to ask questions before the procedure. Spays and neuters are performed commonly, but they’re never routine.